Addressing the Mental Health Needs of Children and Families in the Juvenile Court - PowerPoint PPT Presentation

Loading...

PPT – Addressing the Mental Health Needs of Children and Families in the Juvenile Court PowerPoint presentation | free to download - id: 3b85f5-MTZmY



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Addressing the Mental Health Needs of Children and Families in the Juvenile Court

Description:

Addressing the Mental Health Needs of Children and Families in the Juvenile Court Busting Myths, Breaking Barriers January 9, 2008 Phoenix, Arizona – PowerPoint PPT presentation

Number of Views:660
Avg rating:3.0/5.0
Slides: 101
Provided by: tomrawlin5
Learn more at: http://tomrawlings.com
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Addressing the Mental Health Needs of Children and Families in the Juvenile Court


1
Addressing the Mental Health Needs of Children
and Families in the Juvenile Court
  • Busting Myths, Breaking Barriers
  • January 9, 2008
  • Phoenix, Arizona
  • Presented by
  • Tom C. Rawlings
  • Director, Office of the Child Advocate
  • State of Georgia
  • tom_at_gachildadvocate.org
  • www.tomrawlings.com
  • This Presentation was created in collaboration
    with
  • Melissa Piasecki, M.D.
  • Associate Professor, Dept. of Psychiatry
  • University of Nevada School of Medicine

2
Questions to Answer
  • What does the Juvenile Court do?
  • How do Mental Health and Juvenile Court
    intersect, and Why?
  • How do you figure out what these children need?
  • Do these children belong in the juvenile court
    system?
  • What are some good models for addressing the
    mental health needs of children involved with the
    juvenile court system?

3
Questions to Answer
  • What does the Juvenile Court do?

4
The Courts Jurisdiction
  • Children under 17 accused of a crime.
  • Children under 18 alleged to be deprived
    (neglected or abused) and who need state
    protection.
  • Children under 18 accused of a status offense
  • Children accused of a crime but who are
    incompetent to stand trial

5
Role of the Juvenile Court in Foster Care
  • Primary responsibility of the Court and State to
    foster children reunification of the family
  • To accomplish the goal of stable families
    requires fit parents
  • For parents with mental illness and substance
    abuse, effective mental health services are needed

6
Crimes
Foster Care
Incompetency
Walk-ins
7
Questions to Answer
  • How do Mental Health and Juvenile Court
    intersect, and Why?

8
Mental Health Concerns and Delinquency/Status
Offenses
  • Estimated 15 to 20 rate of severe mental illness
    among juvenile offenders1
  • Less severe mental illness about 401
  • Parents and caregivers often first seek help from
    law enforcement
  • Schools, prohibited from taking long-term
    punitive action against Special Education
    students, often turn to juvenile justice system

1.Arredondo, David E. MD et al, Juvenile Mental
Health Court Rationale and Protocols, Juv. And
Family Ct. Jnl. 52 (4) Fall 2001 1-19.
9
Juveniles in Detention
  • Two-thirds of juvenile detention facilities hold
    youth awaiting mental health treatment 1
  • Santa Clara County, California, 2001 detained
    juveniles2
  • 37 severe traumatic experiences
  • 19 significantly depressed
  • 10 hopelessness
  • 9 psychosis
  • 8 reported suicidal ideation
  • Medication concerns, including refusal

1. U.S. House of Rep, Comm on Govt. Reform
Incarceration of Youth Who are Waiting for
Community Mental Health Services in the United
States (July 2004) 2. Arredondo, David E. MD et
al, Juvenile Mental Health Court Rationale and
Protocols, Juv. And Family Ct. Jnl. 52 (4) 2001
1-19.
10
Prevalence
  • Mood Disorders
  • Anxiety Disorders
  • Substance Use Disorders
  • Disruptive Behavior Disorders
  • Thought Disorders

11
Prevalence
  • 60-70 of youths have a psychiatric disorder (not
    including ADHD/ MR)
  • Pretrial detention
  • Juvenile corrections
  • High rates of co-morbidity
  • 2 to 3 times higher than peers in community

12
U.S. House of Representatives Report
  • Congressional investigators report 15,000
    children with psychiatric conditions were
    improperly incarcerated when mental health
    services were not available
  • These children were as young as 7 years old

13
Epidemiology of Mental Health Problems in
Detained Juveniles
  • Major Depression
  • 18 incarcerated adolescents
  • 4 in community
  • Girls 3X rate as boys

14
Difficulties estimating prevalence of mental
health disorders among youth in the juvenile
justice system
  • Regional variation
  • Use of standardized assessment tools limited
  • Under-sampling of certain populations
  • Youths report of mental health status may vary
    as a function of how long and in what environment
    they have been incarcerated
  • Youth, families, and institutional staff may be
    suspicious of research
  • Inconsistent scope and quality of records to
    provide historical information supporting
    diagnoses

15
Sexual Abuse
  • Studies have found high levels of abuse and
    trauma among delinquent girls
  • 73 of girls entering the correctional system
    reported being victims of abuse (Chesney-Lind
    Sheldon 1998).
  • Other estimates of sexual abuse among delinquent
    girls ranges from 25-70.

16
Trauma
  • 84 of girls in detention experienced major
    lifetime trauma (Lederman et al., 2004).
  • 65 of incarcerated adolescent girls had
    experienced PTSD at some point in their lives
    (Cauffman et al., 1998).

17
Girls and Substance Abuse
  • 75 of detained girls reported regular use of
    alcohol and/or drugs (Acoca 1999).
  • 34 of detained girls had a substance abuse
    disorder (Lederman et al., 2004).

18
Juveniles With Disabilities
  • Prevalence of special education disabilities is
    about 4 to 5 times greater in the juvenile
    justice system than the rate of special education
    disabilities in the community
  • Approximately 30-50 of youth in the correctional
    system have a disability
  • Rutherford, Bullis, Anderson and Griller-Clark
    2002

19
Severely Emotionally Disturbed Students
  • Psycho-educational facility a frequent school
    assignment in rural areas
  • Facility location often remote from home,
    resulting in travel by bus. Hour bus rides not
    uncommon
  • The result poor attendance, continued behavioral
    disturbances, and referral to the juvenile
    justice system

20
(No Transcript)
21
Foster Care and Mental Health
  • Infants and toddlers in the child welfare system
    suffer cognitive and developmental delays 1
  • Among the children of rural migrant workers
  • 66 have one or more psychiatric diagnoses based
    on mother or child reports
  • anxiety disorders most prevalent2

1. Lederman, Cindy S. et al, When the Bough
Breaks the Cradle Will Fall Promoting the
Health and Well Being of Infants and Toddlers in
Juvenile Court, id, 33-37 2. Kupersmidt, Janis B.
et al. J. Am. Acad. Child Adoles Psychiatry
36(2)1997 224-232.
22
Foster Care and Mental Health
  • Children whose parents abuse drugs and alcohol
    are nearly three times as likely to be neglected
  • Children in foster care have higher rates of
    emotional problems than other children of similar
    backgrounds

Allen Bissell. Safety and Stability for Foster
Children The Policy Context. The Future of
Children 14(1) 49-70 (Packard Foundation 2004).
23
Status of Mental Health System and
Evidence-Based Treatments
  • Presidents Commission reports public mental
    health system is in a shambles (Presidents New
    Freedom Commission Report, 2004)

24
Family/ Children Services
Mental Health
Juvenile Justice
Schools
Who Provides the Services?
25
Therapeutic Courts
  • Drug Courts
  • Mental Health Courts
  • Some juvenile courts have created specialized
    juvenile mental health or drug courts
  • Exist predominantly in urban areas with a
    critical mass of clients and providers
  • Source COSCA report, supra

26
The Juvenile Court asa Therapeutic Court
  • Court-based interventions that focus on chronic
    negative behaviors over a period of time in
    conjunction with mandatory treatment.
  • Experts provide treatment and Court ensures
    compliance through sanctions.

Conference of State Court Administrators,
Position Paper on Therapeutic Courts (1999),
available at http//cosca.ncsc.dni.us/PositionPape
rs/therapeuticcourts.pdf
27
The Juvenile Court asa Therapeutic Court
  • Judicial collaboration is regarded as more
    important than judicial independence and
    achieving desired outcomes more important than a
    fair process free of undue influence on the judge

Conference of State Court Administrators,
Position Paper on Therapeutic Courts (1999),
available at http//cosca.ncsc.dni.us/PositionPape
rs/therapeuticcourts.pdf
28
(No Transcript)
29
The Juvenile Court asa Therapeutic Court
  • They workindividuals successfully treated do not
    re-offend, or do so at a much lower rate, thus
    saving money and public resources
  • They require and promote collaboration by courts
    and judges with other agencies and professionals
  • They compel individuals to respect the system and
    participate in the treatment services offered or
    face swift consequences, which is regarded as a
    superior form of accountability to traditional
    sentences
  • Source COSCA report, supra

30
Therapeutic Courts
  • Drug Courts
  • Mental Health Courts
  • Some juvenile courts have created specialized
    juvenile mental health or drug courts
  • Exist predominantly in urban areas with a
    critical mass of clients and providers
  • Source COSCA report, supra

31
Questions to Answer
  • How do you figure out what these children need?

32
Screening and Assessment
  • CAUTION Your presenter is working outside of
    the scope of his license here
  • But we can discuss generally some of the
    methods by which juvenile courts screen kids
  • And we can discuss in-depth the basic issue of
    juvenile competence, which is becoming more and
    more important

33
Screening and Assessment
  • Two different identification processes
  • Screening economical identification applied to
    all youths
  • Assessment more extensive and individualized
    identification of mental health needs for those
    who screened in

34
Resources on Assessment
  • http//www.ojjdp.ncjrs.org/publications/pubabstrac
    t.asp?pubi11936
  • On-line 90 page pdf file
  • Grisso
  • teenscreen.org (National Screening Program)

35
Screening
  • All comers
  • Early contact
  • Focus on acute needs
  • Brief (lt 30 min) less skilled administration
  • Non specific for diagnosis or treatment planning

36
Assessment
  • Selected youth
  • Timing more variable

37
Screening Tools
  • Sensitive to context immediate stress
  • MAYSI 2
  • CAFAS (Medicaid related)
  • Suicide screen

38
Screening Tools
  • Juvenile Justice Doorways
  • Probation intake
  • First contact with the system
  • Pretrial detention
  • Detox, special watch
  • Preadjudication and disposition
  • Competency, waivers
  • Juvenile corrections
  • Community re-entry

39
Screening MAYSI 2
  • Self administered
  • 10 minutes or less
  • Not diagnostic
  • IDs youths in need of assessment
  • Some false positives

40
MAYSI Scales
  • Alcohol/ drug use
  • Angry Irritable
  • Depressed-Anxious
  • Somatic Complaints
  • Suicidal Ideation
  • Thought Disturbance
  • Trauma

41
Questions to Answer
  • Do these children belong in the juvenile court
    system?

42
Assessing Juvenile Competence to Stand
TrialTwo ways to look at it
43
Academic
  • I think the frontal lobe, that part of the
    executive region that we studied, is not always
    functioning fully in teenagers . . . . That
    would suggest that therefore teenagers aren't
    thinking through what the consequences of their
    behaviors are, which would lead us to believe
    that they'd be more impulsive, because they're
    not going to be so worried about whether or not
    what they're doing has a negative consequence.
  • -Dr. Deborah Yurgelun-Todd, McLean Hospital,
    Harvard University

44
Non-Academic
  • Son, you dont yet have good judgment.
  • -William Rawlings, Sr.,
  • circa 1984

45
Juvenile Competence
  • S. H. 12-year old Georgia boy with IQ
    equivalent to six year-old, attempts anal
    penetration of another child.
  • Juvenile court finds him incompetent but
    adjudicates him delinquent and jointly commits
    him to juvenile justice and child protection
    agencies.
  • Georgia law does not provide a statutory
    framework in order to protect juveniles rights
    not to be tried in a delinquency proceeding while
    they are incompetent.
  • In the Interest of S.H., 220 Ga. App. 569, 570
    (1996)

46
Juvenile Competence
  • Appeal argues that even in juvenile court, an
    incompetent child cannot be adjudicated.
  • Court
  • purpose of the Juvenile Court Code is to assist,
    protect, and restore children whose well-being is
    threatened as secure law-abiding members of
    society
  • To promote this commendable purpose, the General
    Assembly created a comprehensive civil forum for
    treating and protecting juveniles, "replete with
    distinctions between criminal matters and matters
    concerning juveniles alleged delinquent."
  • Juvenile proceedings emphasize treatment and
    rehabilitation, and spare the child some of the
    collateral consequences of a criminal conviction.

47
Juvenile Competence
  • Court
  • As is evident in this case, however, the
    consequences do not always differ. Both juvenile
    and criminal proceedings may result in a
    significant loss of liberty.
  • Constitutional considerations must necessarily
    transcend even the most admirable legislative
    purposes.
  • The juvenile charged with "delinquency" is
    entitled by right to have the court apply those
    common law jurisprudential principles which
    experience and reason have shown are necessary to
    give the accused the essence of a fair trial.

48
Juvenile Competence
  • Without question, these include the right to
    adequate notice of the charges, appointment of
    counsel, the constitutional privilege against
    self-incrimination, and the right to confront
    opposing witnesses.
  • We believe the cornerstone of these substantive
    rights is competence to understand the nature of
    the charges and assist in a defense. A want of
    competence renders the other rights meaningless.
  • It has long been accepted that a person whose
    mental condition is such that he lacks the
    capacity to understand the nature and object of
    the proceedings against him, to consult with
    counsel, and to assist in preparing his defense
    may not be subjected to a trial.
  • Principles of fundamental fairness require that
    this right be afforded in juvenile proceedings.

49
Juveniles Understanding of Their Rights
  • Grisso et al. study
  • 1,400 individuals ages 11 to 24
  • detained in juvenile detention facilities or
    adult jails vs.
  • those residing in the same or similar communities
    as the detained participants but who had never
    been held overnight in the justice system.
  • Then compared the performance of 11-17-year olds
    with young adults (aged 18-24)
  • Laurence Steinberg, Juveniles Competence to
    Stand Trial
  • http//www.jcpr.org/policybriefs/vol5_num1.html
  • Grisso Study
  • http//www.abanet.org/crimjust/juvjus/12-3gris.htm
    l

50
Juveniles Understanding of Their Rights
  • Instruments
  • MacArthur Competence Assessment Tool-Criminal
    Adjudication (MacCAT-CA)
  • MacArthur Judgment Evaluation (MacJEN).
  • Also assessed mental health problems,
    psychosocial maturity, and intelligence in
    conjunction with these tests.

51
Juveniles Understanding of Their Rights
  • Findings Developmental incompetence prominent
    among young teens.
  • one in three 11-13-year-olds
  • one in five 14-15-year-olds

52
Juveniles Understanding of Their Rights
  • Findings
  • Youth aged 11-13 were consistently found to be
    less capable in judgment, understanding, and
    reasoning than older youth.
  • 30 of 11-13-year-olds and 20 of
    14-15-year-olds, showed significantly impaired
    understanding or reasoning
  • Competence increased progressively until age 16
  • only 10 of the 16-17-year-olds or young adults
    showed impaired competence
  • Those older than 16 varying little from the young
    adults in the sample

53
Juveniles Understanding of Their Rights
  • Findings Teens are more compliant with
    authority.
  • The younger a teen, the more likely, he or she
    was to recommend confessing to a crime rather
    than remaining silent during a police
    interrogation.
  • One-half of 11-13-year-olds recommended
    confessing, while only 20 of young adults did
    so.
  • Grisso A younger adolescent is more likely to
    think of the immediate consequence They might
    send me home tonight if I say I did it rather
    than the impact of the decision on later events
    in court
  • 74 of 11-13-year-olds recommended accepting a
    plea agreement, while only 50 of young adults
    did.

54
Juveniles Understanding of Their Rights
  • Implications
  • a competency determination should be made a
    condition of criminal adjudication whenever a
    transfer to adult court is being considered for
    young adolescents. (L. Steinberg)
  • when youth are first charged in adult court, a
    determination of competence automatically precede
    the adjudication of youth whose age places them
    at risk for lack of competence . (L. Steinberg)
  • ABA Juveniles should have an unwaivable right
    to counsel

55
Juveniles Understanding of Their Rights
  • Implications
  • a competency determination should be made a
    condition of criminal adjudication whenever a
    transfer to adult court is being considered for
    young adolescents. (L. Steinberg)
  • when youth are first charged in adult court, a
    determination of competence automatically precede
    the adjudication of youth whose age places them
    at risk for lack of competence . (L. Steinberg)
  • ABA Juveniles should have an unwaivable right
    to counsel

56
Juveniles Understanding of Their Rights
  • Implications
  • Current research suggests that by age 13 or 14,
    the average youth tends to have a basic idea of
    the roles of persons in the trial process.
    Further, they can understand that defendants are
    charged with offenses and that the consequences
    may be punitive. More questionable is their
    ability to deal with abstract legal concepts that
    are grasped by the majority of adults.
  • For example, adults typically see a legal right
    as an "entitlement," which is provided to them by
    law and cannot be revoked. In contrast, research
    suggests that children think of a right as
    "conditional"-- something that authorities allow
    them to have, but which could also be retracted.
    It is only around ages 13 or 14 that youths
    develop the capacity to think of a right as
    "belonging" to them, which they may assert or
    waive. (Grisso)

57
Juveniles Understanding of Their Rights
  • Implications
  • Age, by itself, is a poor indicator of whether
    youths between ages 14 and 16 have reached an
    adult level of knowledge about the legal process,
    or an adult's capacity to understand it.
  • The evidence suggests that some youths between
    the ages of 14 and 16 are not markedly different
    from adults in their abilities related to
    competency to stand trial. Yet the range of
    abilities among youths at any of these ages is
    much greater than among adults. (Grisso)

58
Juveniles Understanding of Their Rights
  • Implications
  • Defendants below the statutory age for juvenile
    jurisdiction may be found incompetent for reasons
    of developmental immaturity in both juvenile and
    criminal court.
  • The threshold for competency to stand trial--the
    degree of ability required--should be considered
    lower for adjudication in juvenile court than in
    criminal court. A lower threshold for competence
    in juvenile court might be justified on the basis
    of the lesser severity of consequences of
    adjudication on delinquency charges, as well as
    the continuing obligation to provide
    rehabilitative services to youths found
    delinquent. (Grisso)

59
Competency Assessments
  • What to Ask For
  • the examiner appointed by the court will be
    qualified to evaluate children and to perform
    competency to stand trial evaluations
  • the examination will include not only an
    assessment of mental disorder, but also an
    assessment of developmental disabilities and
    cognitive and social developmental status and
  • The assessment will include the full range of
    abilities relevant for competency to stand trial
    (a) understanding of the charges, consequences
    and trial process, (b) cognitive, attentional,
    communication, and interpersonal abilities
    relevant for assisting counsel meaningfully, as
    outlined earlier in this review, and (c)
    capacities for decision making about rights that
    are essential for due process.
  • Grisso

60
Georgia Competency Procedure
  • Whenever there is reason to doubt competency
  • "Mentally competent" means having sufficient
    present ability to understand the nature and
    objectives of the proceedings, against himself or
    herself, to comprehend his or her own situation
    in relation to the proceedings, and to render
    assistance to the defense attorney in the
    preparation and presentation of his or her case
    in all adjudication, disposition, or transfer
    hearings held pursuant to this chapter. The
    child's age or immaturity may be used as the
    basis for determining the child's competency.

61
Georgia Competency Procedure
  • Done by a Qualified Examiner Within 30 Days
  • Report Must Contain
  • 1) The reason for the evaluation
  •    (2) The evaluation procedures used, including
    any psychometric instruments administered, any
    records reviewed, and the identity of any persons
    interviewed
  •  (3) Any available pertinent background
    information 
  •   (4) The results of a mental status exam,
    including the diagnosis and description of any
    psychiatric symptoms, cognitive deficiency, or
    both  (5) A description of abilities and
    deficits in the following mental competency
    functions      (A) The ability to understand
    and appreciate the nature and object of the
    proceedings      (B) The ability to comprehend
    his or her situation in relation to the
    proceedings and      (C) The ability to render
    assistance to the defense attorney in the
    preparation of his or her case   (6) An opinion
    regarding the potential significance of the
    child's mental competency, strengths, and
    deficits   (7) An opinion regarding whether or
    not the child should be considered mentally
    competent and   (8) A specific statement for
    the basis for a determination of incompetence.

62
Georgia Competency Procedure
  • (d) If, in the opinion of the qualified examiner,
    the child should not be considered mentally
    competent, the qualified examiner shall complete
    a full mental health evaluation and report
    pursuant to and such report shall also include
    the following   (1) A diagnosis made as to
    whether there is a substantial probability that
    the child will attain mental competency to
    participate in adjudication, a disposition
    hearing, and a transfer hearing in the
    foreseeable future   (2) A recommendation as
    to the appropriate treatment setting and whether
    residential or nonresidential treatment is
    required or appropriate   (3) Where
    appropriate, recommendations for the general
    level and type of remediation necessary for
    significant deficits and   (4) Where
    appropriate, recommendations for modifications of
    court procedure which may help compensate for
    mental competency weaknesses.

63
Georgia Competency Procedure
  • Burden of Proving Incompetence is on child
  • By a Preponderance of the Evidence
  • If Child is Incompetent
  • Misdemeanor or unruly, may dismiss
  • Felony, create a competency plan
  • Competency plan has a manager who
  • Convenes all interested parties and providers
  • Determines childs needs and a plan of action
  • Either restore competence or, more likely, treat
    the childs needs as a dependent of the court.
  • Review every six months, or dismiss after two
    years

64
Questions to Answer
  • What are some good models for addressing the
    mental health needs of children involved with the
    juvenile court system?

65
Addressing the Problems A Practical Approach
  • Courts must take a clinical approach to the
    situation, and mental health providers must
    consider the court process in making
    recommendations
  • Courts and mental health providers must work
    together to accomplish the broader goal of
    treatment and rehabilitation

66
(No Transcript)
67
What to Look For In A Provider
  • NO FIXED FACILITIES!
  • Providers need to be willing to go where the
    children are and to work with both child and
    childs family in their community, in their
    school, and in court
  • MST, Intensive Family Intervention, Targeted Case
    Management, Wraparound Services, etc. etc.

68
What to Look for in a Provider
  • Court-Provider Partnerships
  • In Emanuel County, former Community Mental Health
    therapists were encouraged to provide Intensive
    Family Intervention services funded by Medicaid.
  • Medicaid will fund 90 days treatment for a child
    with a mental Health diagnosis who is at risk of
    out-of-home placement.
  • Services are provided in-home or wherever the
    child can be found counseling is given to
    families as well, and provider serves as a case
    manager for other referrals.
  • Of those served, 79.2 had never received
    traditional mental health services. All had
    CAFAS scores in excess of 100, and 53 had CAFAS
    scores in excess of 160.

69
What to Look for In a Provider
  • Consider a Juvenile Mental Health Court
  • First one in CA in 2001, a growing trend
  • Usually smaller caseloads
  • Eligibility criteria vary
  • About half limit to more severe MH problems
  • Usual referral point after adjudication, before
    disposition
  • www.ncmhjj.com/pdfs/publications/JuvenileMentalHea
    lthCourts.pdf

70
What to Look for In a Provider
  • Consider a Juvenile Mental Health Court
  • Monitor progress through regular judicial reviews
    in addition to usual probation methods
  • Time varies between 3 months and two years,
    usually 10-18 months
  • Case expunged after completion

71
What to Look for In a Provider
  • Consider a Juvenile Mental Health Court
  • Benefits
  • Judicial Leverage
  • Multi-Disciplinary Approach
  • Increased Options for Treating Youth with Mental
    Health Issues

72
What to Look For In A Provider
  • MEDICAID ELIGIBILITY
  • All children otherwise eligible for Medicaid are
    entitled to all services, even those not within
    the usual State Plan, under the Early and
    Periodic Screening, Diagnosis, and Treatment
    provisions of 42 USC 1396dd
  • Check your states Medicaid Manuals and Medicaid
    Audits

73
What to Look For In A Provider
  • BEWARE THOSE WHO HIDE BEHIND PRIVACY LAWS
  • No provider can help you help the child if they
    are constantly worried about HIPAA or federal
    drug treatment laws.
  • Court always has the authority to order the
    provider to share records except perhaps some
    treatment records covered by the provider-patient
    privilege
  • Even then, patient or guardian ad litem can sign
    a waiver

74
What to Look For In A Provider
  • Focus on System of Care
  • http//systemsofcare.samhsa.gov/
  • Every Child Needs a Medical Home
  • The American Academy of Pediatrics describes the
    medical home as a model of delivering primary
    care that is accessible, continuous,
    comprehensive, family-centered, coordinated,
    compassionate, and culturally effective care.
  • www.medicalhomeinfo.org

75
Georgias KidsNet ? A System of Care Helping
troubled kids stay in the mainstream of life
76
(No Transcript)
77
Georgias KidsNet ? A System of Care Where it
all started
1999 SAMHSA awards Rockdale County a 6-year
grant to develop a system of care for kids with
Severe Emotional Disturbance (SED)
2003 SAMHSA awards Georgia a 6-year grant to
develop state-level infrastructure (policies,
training, financing) for that system of care
2004 Georgia becomes one of only 3 states to be
awarded a second infrastructure development
grant this one to develop state-level support
for a system of care approach to kids with drug
and alcohol problems
2005 SAMHSA approves Georgias proposal to match
with State funds the remaining 1M federal funds
in Rockdales grant and expand KidsNet into 12
other counties. State funds come from DHR and DJJ.
2008 to be continued
78
What is the need in Georgia?
2,452,225 Georgia children youth from birth to
age 17
183,917 about 7.5 -- have some form of SED
HOW MANY ARE BEING SERVED IN GEORGIA?
3,197 in residential treatment (DJJ) 1,988 in
group homes, residential care (DFCS) 1,659 in
short term hospital care (DMHDDAD) 1,598 in
institutions (DFCS) 22 in long-term hospital care
(DMHDDAD)
79
Where are SED kids treated now?
Kids with multiple problems likely need services
from multiple agencieseach treating one part of
the syndrome in a separate case.
CHILDHOOD HISTORY
Physically abused 42 Psychiatric hospital
24 Sexually abused 30
Runaway 39 Suicide attempt
24 Substance abuse 11.5
Consequently, kids can slip through the cracks
between compartmentalized providers into the
deepest end of the System residential care,
hospitalization, detention.
80
Where theres a Kid,theres a Family
The family may be facing their own issues
  • Alcohol/substance abuse
  • Child neglect/abuse
  • Domestic violence
  • Mental illness
  • Criminal activity, parent in prison

81
(No Transcript)
82
Where to turn KidsNet
In 1999 Rockdale County joined a national network
of communities forging a multi-agency System of
Care. Its a circle of services with a family
at the center.
83
Georgias KidsNet What is it?
PROFILE OF SED
A community-based process for delivering mental
health services to children with Serious
Emotional Disturbance (SED).
  • Lack of self-control
  • Defiant
  • Difficulty getting along with others
  • Depressed or suicidal
  • Dysfunctional family life
  • In out of child services
  • Impaired ability to learn
  • Low self-esteem
  • NOT typically delinquent

Who does it?
Staff from DHR DJJ, family members, Juvenile
Court Judges, school teachers, counselors, MH
service providers
84
How KidsNet is different from other mental health
services
KidsNet is directed by a process theory that
believes outcomes are better for children, youth
and families when services are provided
  • in community-based, least restrictive
    environments
  • through interagency coordination and
    collaboration
  • in ways that are family-driven, youth-guided and
    culturally appropriate

85
How does KidsNet work?
7
86
All the difference
Because of KidsNet, our family is starting to
come together.
  • Key KidsNet Staff
  • Service Coordinator contacts providers
  • Family Advocate guides, assists family
  • Case Manager stays on top of plan, outcomes
  • Mental Health Clinician screens child for Mental
    Health/Substance Abuse
  • Behavioral Aide assists with social skills
  • Care planning
  • Comprehensive, consistent, coordinated,
    collaborative
  • Assembles all the right resources, public
    private
  • Unified Service Plan and case report follows the
    child
  • Pool of flexible funds for creative solutions --
    e.g., camps, learning tools

87
Who are Kids in Crisis?
88
KidsNet Rockdale Clients
KidsNet Family History Alcohol/Substance Abuse
Treatment 66.7 Family Violence
63.3 Psychiatric Hospitalization
56.5 Mental Illness 56.5 Crime
Conviction 53.8 Family
Children Services 49.3
KidsNet Child History Family Children Svcs
49.3 Physically Abused 40.4 Psychiatric
Hospitalization 40.0 Sexually Abused
38.8 Runaway 37.5 Suicide
Attempt 23.2 Alcohol/Substance Abuse
Treatment 13.0 Sexually
Abusive 11.5
89
Where is KidsNet today?
One Regional Collaborative in NW Georgia
Six Individual Counties
  • Haralson
  • Polk
  • Floyd
  • Dade
  • Walker
  • Bartow
  • Paulding
  • Rockdale
  • Newton
  • Chatham
  • Fulton
  • Gwinnett
  • Douglas

Who are the members of local KidsNet sites?
  • Family members
  • Juvenile Court Judges
  • Staff from DJJ, DFCS, MH
  • Local school staff
  • CSB staff
  • Local MH service provider
  • Family Connection staff
  • Family Advocate
  • Project Coordinator

9
90
Spreading the Net KidsNet in 2007/2008
91
Is System of Care an effective approach?
YES. Here are results of a national study of 121
programs, including KidsNet Rockdale
YES.
Bad indicators went down
Good indicators went up
92
KidsNet Outcome
The Child Adolescent Functional Assessment
Scale assesses the degree of impairment in
functioning due to emotional, behavioral, or
psychiatric problems.
C A F A S Mean Score for 22 KidsNet Youth
LOWERING the LEVEL of IMPAIRMENT
INTAKE
DISCHARGE
6 MONTH FOLLOWUP
1 YEAR FOLLOWUP
93
School Progress Intake to 6 months
PERFORMANCE
ATTENDANCE
REPORT CARD
IMPROVED
STABLE
KIDSNET Rockdale
NATIONAL Aggregate
KIDSNET Rockdale
NATIONAL Aggregate
94
School Suspensions Expulsions Intake to 6
months
SUSPENSION
SUSPENSION
EXPULSION
EXPULSION
NATIONAL Aggregate
KIDSNET Rockdale
95
Living in One Home Intake to 6 months
Intake
6 Months
Intake
6 Months
?
?
?
?
KIDSNET Rockdale
NATIONAL Aggregate
96
Out-of-Home Placements for Rockdale and other
KidsNet Counties
Residential or Out-of-Home Placements
Rockdale Other KidsNet Counties
97
From Financial Mapping Study
  • In FY06 55 of expenditures across the four
    major State spending agencies (not including
    education) is being spent on restrictive levels
    of care for about 6 of the total population of
    youth receiving behavioral health services.

98
Georgias Treatment System ()
More Expensive
Less Expensive
FY06
xxM xxx youth xx/youth
Student Support Team (SST) xx XXX Yth xxx/Yth
Alternative School 1 xx XXX Yth xxx/Yth
Psycho Ed xx XXX Yth xxx/Yth
ED
98.6M 241,000 youth 408/youth
OP Hospital 12.9M 33,500 yth 385/yth
Rx
IP Hospitalization 22.4M 8,500
yth 2,600/yth
Physician Svcs 25.2M 138,300 yth 182/yth
Psych Svcs 28.4M 45,000 yth 631/yth
DCH
State Psych Beds 7.6M 1,681 45,000/Yth
Community-GIA/MRO 118M 53,000 Youth 2,225/Youth
OTP 4.2M 180 Yth 23,000/Yth
130M 58,000 youth 2,370/youth
MH
TCM 39.4M 37,500 youth 1,050/youth
CCI 170.9M 10,600 youth 16,122/youth
CPAs 69.2M
CCI Parent 19.1M 300 yth 67,706/yth
Non- LOC Svcs 10.8M 192 youth 56,250/yth
Wrap Svcs 3.8M 192 youth 20,000/yth
300M 50,000 youth 600/youth
DFCS
TCM 8.9M 6,500 youth 1,362/youth
LOC 52.6M 2,025 youth 26,000/youth
Non-LOC Svcs 300k 192 yth 20,000/yth
YDC/RYDC Svcs ?? 9,900 youth
61.8M 18,500 youth 3,340/youth
DJJ
591M
Less Desirable Outcomes
Best Outcomes
99
What people are saying
Sometimes I thought I wasn't going to make it but
KidsNet has brought my son and me a long
way.  --Parent, KidsNet Rockdale
I have a better attitude about life! Im not as
impulsive in my decision making. - Youth
Its helped me learn a bunch of things. Its
helped me through my past. Teen-ager,
Savannah
If I weren't with y'all, I would be back in
juvenile for hanging out with that crowd. L. A.,
KidsNet Newton
KidsNet is straight. They help keep me out of
trouble and they are there for me. Youth,
KidsNet Rockdale
The System of Care information and referrals have
become an intricate part of my considerations in
making dispositional decisions relating to
treatment and rehabilitation of our children.  
Billy J. Waters, Juvenile Court
Judge, Alcovy Judicial Circuit, KidsNet Newton
I never thought this family would ever be
considered for having their kids placed back in
the home. DFCS-Newton
100
This Powerpoint Can Be Yours!
  • Visit www.tomrawlings.com
  • Email me tom_at_gachildadvocate.org
  • Call me (478) 757-2661
About PowerShow.com